A wide variety of chemical substances of both natural and synthetic origin is known to effect reduction of glycemia on oral administration. During the past some ten years, investigators have demonstrated that oral administration of aryl. sulfonylureas can substitute for exogenous insulin in mild, usually obese and elderly diabetic patients. The narrow range of applicability of these d ugs has recently been, stressed, with some, severe toxic reactions have been reported. The search for a safe, effective oral insulin substitute still continues.
A new synthetic drug, n´,beta-phenethyIfornmidjijylnajnourea(D.B. I.) unrelated to the ary Isulfonyl ureas has been evaluated in the laboratory animals. Given orally, it effectively lowers b ood sugar levels in alloxan treated diabetic rats, rabbits, and Rhesus monkeys.
Though many investigators, have also been experienced on its effectiveness in treatment of the human diabetics, the-site and mode of action are still obscure. The present report deals itb ,comparative studies of the clinical effectiveness following, sulfonylurea; preparations or biguanide therapy in 74 patients with diabetes mellitus and the clinical results were compared with each other.
Out of 74 patients, 36 hospitalized were almost moderate severe diabetics but the remains ere mild or moderate outpatient of diabetes mellitus:
Our attempts could be made to select those types fit for biguanide therapy under the car-ful -study of the clinical characteristics responded well to its, agent. The grade of reponsiveness to sulfonylurea or biguanide was evaluated from the reduction of blood sugar levels, namely the fasting and postprandial blood-sugar levels and the urine sugar value.
In all patients, who were treated with sulfonylurea : or bigunide alone but some cases with c mbiped therapy the periodic determination of the blood sugar as well as the urine sugar ere performed.
There are often experienced cases with gastrointestinal trouble following biguanide administration. We also analyzed the gastric acidity for them. The biguanide preparations were applied mainly phenformin(D. B3: ),
The results of the present studies areas follows:
1. Biguanide preparations were more effective in about half of the total patients for the evaluation of blood and urine sugar value within a given time during sulfonylurea or biguanide therapy.
2. Particularly, the postprandial blood sugar and urine sugar levels were favorable amon those who responded well to biguanide, but fasting blood sugar levels were favorable to sulfonylurea good responders.
3. Almost half of biguanide-good responders included those poor responders to insuline but all of them were better responders to sulfonylurea comparing to insulin.
4. Abnormal thresholds of urine sugar excretion were seen comparatively in some numbers of biguanide-good responders.
5. Most of them, manifested with gastrointestinal troubles following. biguanide, were found to be hypoacidity of anacidity.
The above clinical studies seems to be a guided for the applicability of biguanide, according to the types of diabetes.
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